Does this patient really have chronic obstructive pulmonary disease?

Chronic obstructive pulmonary disease (COPD) is a condition commonly encountered by primary care practitioners. The disease should be detected in its early stages to prevent disease progression and to reduce the burden of symptoms. Early treatment also results in improved mortality and reduced morbidity. COPD should be differentiated from other similar conditions such as asthma, as the basis of treatment differs in these conditions, and misdiagnosis can lead to poorer patient outcomes. Non-pharmacological treatment such as smoking cessation and vaccinations are important in the management of COPD, while pharmacotherapy such as bronchodilators and antimuscarinics are the mainstay of therapy in COPD. Referral to a specialist is recommended when there is progression of the disease or uncertainty regarding the diagnosis.     

踝关节重度骨关节炎行关节镜下踝关节融合术的临床研究

目的探讨对踝关节重度骨关节炎采用关节镜下踝关节融合术的近期疗效和手术要点。方法 2007年7月至2012年12月,本科采用关节镜直视下的踝关节融合术共治疗25例重度踝关节骨关节炎,这些患者在门诊保守治疗后仍疼痛明显。术前行踝关节正侧位摄片和磁共振检查,术中建立踝关节镜通道,首先彻底清除残留关节面软骨,然后行关节端"微骨折"处理,初步复位踝关节于功能位,克氏针临时固定,"C"臂机透视确认后,旋入空心螺钉。术后石膏托固定6周,然后在保护下部分负重锻炼直至骨性愈合。记录术前和术后1年的疼痛评分,并进行统计学分析。结果所有患者获得随访,均在术后10~16(12±1)周骨性融合,疼痛缓解,步态改善;有1例同期实施小切口辅助下的距下关节融合术。未出现切口愈合不良和感染的早期并发症,随访1~5年,有2例单纯踝关节融合术后患者出现距下关节炎伴轻度疼痛,经保守治疗后症状缓解未进一步手术。根据疼痛评分,术前评分(7.9±1.4)分,术后1年评分(2.1±0.8)分,差异有统计学意义(P=0.005)。结论对保守治疗无效的重度踝关节骨关节炎患者,采用关节镜下的踝关节融合术,具有创伤小、切口美观、融合率高等优势,但同时存在设备要求和学习曲线的前提条件。     

孕激素膜受体1在早产胎膜早破患者胎膜组织中的表达

目的：探讨孕激素膜受体1（PGRMC1）在早产胎膜早破患者胎膜组织中的表达情况。方法选择2012年9月至2013年9月我院在临产前行剖宫产终止妊娠的孕妇60例,分为早产胎膜早破组（ pPROM）、早产未临产组（ pTNL）和足月未临产组（ TNL）,每组各20例,采用免疫组织化学SP法检测胎膜组织中PGRMC1的表达和分布情况,并比较其差异。结果三组间PGRMC1表达有明显差别,pPROM组PGRMC 1表达最低,而在pTNL组表达最高（ P＜0．05）。 pPROM组PGRMC1在破口处胎膜组织较破口旁表达明显减低,差异有统计学意义（P ＜0．05）。结论 PGRMC1表达减少与pPROM 的发生有关, PGRMC1有望成为早产的特异性治疗靶点。     

Lack of immunological or molecular evidence for a role of mouse mammary tumor retrovirus in primary biliary cirrhosis

BACKGROUND & AIMS: Recent observations, including a pilot clinical trial, have suggested that a human mouse mammary tumor virus (MMTV) causes primary biliary cirrhosis (PBC). We attempted to confirm such data. METHODS: We obtained sera from 101 patients (53 with PBC and 48 controls), fixed liver sections from 10 patients (8 PBC and 2 controls), fresh liver specimens (6 PBC and 6 controls), and fresh peripheral blood lymphocytes (PBLs) (10 PBC and 10 controls). We studied sera for reactivities against 3 different strains of MMTV virions, MMTV(C3H), MMTV(FM), and MMTV(LA), including goat polyclonal antibodies against MMTV virions, gp52, and p27 as positive controls. We stained liver specimens using polyclonal antibodies against MMTV and gp52 and further examined tissue samples and PBLs for specific MMTV genome sequences. RESULTS: By Western blot analysis, no detectable reactivity in any of the PBC sera against any of the 3 MMTV strains or MMTV gp52 or p27 was observed. However, viral proteins were recognized by our control positive polyclonal antibodies. We note that 13%-60% of PBC sera presented low reactivity against 2 proteins of approximately 57 and 74 kilodaltons. Such reactivity is related to the trace amounts of mitochondrial antigens in the virus preparations derived from murine mammary tumor tissue. No detectable immunohistochemical or molecular evidence for MMTV was found in the liver specimens or PBLs. CONCLUSIONS: We were unable to recapitulate the data on this specific retroviral etiology of PBC and suggest that such data could be the result of contamination.     

Primary sclerosing cholangitis (PSC): clinical,laboratory and survival analysis in children and adults

Abstract: Background: Primary sclerosing cholangitis (PSC) is an uncommon disorder, rarely diagnosed in children, moreover, data on its natural history and survival are still lacking. Aim: The study was undertaken to compare clinical, laboratory and survival rates in two series of PSC: one in a pediatric group (group A) and the other in an adult population (group B). Methods: Group A included 9 patients (5 males, 4 females, mean age 10 yrs, range 7–15); group B included 28 patients (19 males, 9 females, mean age 32 years, range 19–60). The mean follow-up was 5.2 years in group A and 6.9 years in group B (range 1–14 years). ERCP and colonos-copy were performed in each case. Survival was analyzed using the Kaplan-Meier method. Results: At presentation children showed significantly higher levels of IgG and AST compared to adults (p<0.05); moreover, interface hepatitis occurred in 50% of children and in 14.2% in adults (p= ns). During follow-up the following major events occurred: oesophageal bleeding (n=2) in group A; progressive liver failure (n=6), cholangiocarcinoma (n=3), colonic cancer (n=1) in group B. Liver transplantation (OLTx) was performed in 4 adults (one died after a retransplantation). No deaths were observed in children. The Kaplan-Meier curve in adults shows a 65% rate of survival at 10 years. Conclusions: The present findings on PSC suggest a more severe activity of the disease in children than in adults at presentation; nonetheless, the prognosis seems to be better in children than in adults. The Mayo score prognostic index does not predict the development of liver/colonic cancer. A poor outcome (defined as death or being listed for OLTx) only occurred in adults.     

Nonroutine Use of Intra-Aortic Balloon Pump in Cardiogenic Shock Complicating Myocardial Infarction With Successful and Unsuccessful Primary Percutaneous Coronary Intervention

Objectives

The authors sought to compare outcomes of patients with myocardial infarction and cardiogenic shock (CS) treated with percutaneous coronary intervention (PCI) with or without intra-aortic balloon pump (IABP) support according to final epicardial flow in the infarct-related artery.

Prognosis and first diagnostic ECG in STEMI patients referred to the emergency medical system for primary PCI

Background

Pathological Q waves (QWs) in the first ECG recorded at hospital admission has been found to correlate with myocardial damage and mortality in STEMI patients. We investigated the association between new QWs recorded in the pre-hospital setting and adverse outcome during the hospital stay.

心衰患者窦性心率震荡检测及多因素影响分析

目的　观察心力衰竭患者窦性心率震荡 (HRT)现象的特征并探讨其临床意义。方法　 2 0 0 4 - 0 1～ 0 4哈尔滨医科大学第一临床医学院门诊 30例心衰患者及 30名健康对照者均接受 2 4hHolter检查 ,分别计算HRT的初始值 (TO)、HRT的斜率 (TS) ,并进行TO、TS与年龄、左室射血分数 (LVEF)、左室舒张末期内径 (LVED)、室早数目、室早前心率、联律间期、代偿间期的相关分析及不同起源室早TO、TS的组间比较。结果　心衰者与健康者HRT间存在明显差别 :心衰者TO明显高于对照者 (0 5 7± 4 71%与 - 1 5 6± 2 6 0 % ,P <0 0 2 5 ) ;心衰者TS明显低于对照者 (3 17± 2 0 3%与 9 6 4± 6 4 7,P <0 0 0 1)。TO、TS与年龄、LVEF、LVED、室早数目相关 ,与室早前心率、联律间期、代偿间期不相关 ,起源不同室早的TO、TS间无明显差异。结论　慢性心衰患者中窦性心率震荡现象明显减弱 ,由于TO、TS与LVEF、LVED相关 ,可凭借TO、TS对心衰患者进行危险分层 ,但它对预后的预测价值有待于大样本长期随访来证实。